2012年版EASL慢性乙型肝炎管理指南课件.ppt

* PEG-IFN may increase the risk of bacteraemic infection and hepatic decompensation in patients with advanced cirrhosis。However, PEG-IFN in regimens similar to those used in CHB can be used for the treatment of well compensated cirrhosis Among NAs, monotherapies with tenofovir or entecavir are preferred because of their potency and minimal risk of resistance [148,149] (A1). Lamivudine should not be used in such patients. * The HCC risk is high in these patients even under effective NA therapy and therefore long-term HCC surveillance is mandatory [152] (A1). ABSTRACT Objective To evaluate the risk and predictors of hepatocellular carcinoma (HCC) in HBeAg-negative chronic hepatitis B patients of the large HEPNET.Greece cohort study who received long-term oral antivirals starting with lamivudine monotherapy. Design Retrospective analysis of HCC incidence in HBeAg-negative chronic hepatitis B patients from a retrospectiveeprospective cohort who were treated with nucleos(t)ide analogue(s) starting with lamivudine monotherapy for $12 months. Setting A nationwide network of liver centres. Patients 818 patients were included: 517 with chronic hepatitis B only; 160 with compensated cirrhosis; 56 with decompensated cirrhosis; 85 with unclassified disease severity. Interventions All patients were treated with nucleos(t)ide analogue(s) starting with lamivudine monotherapy. Main outcome measures Development of HCC. Results During a median follow-up of 4.7 years, HCC developed in 49 (6.0%) patients. The 5-year cumulative incidence of HCC was higher in patients with cirrhosis than in those with chronic hepatitis B only (11.5% vs 3.2%, respectively; p0.001). HCC developed in 0.7%, 6.7% and 11.7% of patients 50, 50e60 and 60 years old, respectively (p0.001). Virological on-therapy remission did not significantly affect the incidence of HCC in all patients or those with cirrhosis, but it showed a trend for lower HCC incidence in patients with chronic hepatitis B only (p?0.076). I